Numerous studies have examined exposures to indoor combustion products such as secondhand smoke and emissions from burning of solid fuels. However, only a few have examined incense burning as a potential health threat, even though incense is commonly used for religious and ritual purposes in China, Taiwan, Singapore, India, and Middle Eastern nations.1,2In this issue of EHP, investigators report an association between long-term incense use and increased cardiovascular mortality.1

The study used data from the Singapore Chinese Health Study, which enrolled a cohort of 63,257 Chinese adults aged 45–74 years between 1993 and 1998. The authors identified cardiovascular deaths of cohort members via a nationwide death registry, checking the registry yearly through 31 December 2011.

More than three-quarters of the participants reported currently using incense, and another 13% were former users. Most had used incense daily for at least 20 years, typically keeping it burning intermittently throughout the day. The authors estimated that current long-term incense users had a 12% increased risk of cardiovascular mortality compared with former and never users, including a 19% increased risk for stroke and a 10% increased risk for coronary heart disease.1

In contrast with outdoor air pollution, incense exposure may be easier for an individual to avoid, but Yeatts says education will be needed to help people understand the risks of these exposures, similar to educational campaigns about cigarette smoking.Koh published an earlier prospective study that found an association between incense use and upper respiratory cancer.7